1. Chapter 58 Otic Drugs Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

2. 2

3.  Bacterial and fungal infections  Inflammatory disorders that cause pain  Earwax accumulation  External ear  Physical trauma  Dermatitis  Middle ear  Otitis media Ear Disorders Copyright © 2014 by Mosby, an imprint of Elsevier Inc.3

4.  Otitis media: middle ear infection  Most often afflicts children and follows an upper respiratory tract infection  In adults, usually results from foreign objects or water sports Ear Disorders (cont’d) Copyright © 2014 by Mosby, an imprint of Elsevier Inc.4

5.  Otitis media: middle ear infection (cont’d)  Symptoms include pain, fever, malaise, pressure, sensation of fullness in the ears, hearing loss  If untreated, tinnitus, nausea, vertigo, mastoiditis may occur  Hearing deficits and hearing loss may result if prompt therapy is not started Ear Disorders (cont’d) Copyright © 2014 by Mosby, an imprint of Elsevier Inc.5

6. Classroom Response Question A 2-year-old is seen in the pediatrician’s office with a bacterial middle ear infection. Which medication does the nurse anticipate being prescribed for the child? A.amoxicillin B.Cortic C.carbamide peroxide (Debrox) D.Acetasol HC Copyright © 2014 by Mosby, an imprint of Elsevier Inc.6

7.  Antibiotics  Antifungals  Antiinflammatories  Local analgesics  Local anesthetics  Corticosteroids  Earwax emulsifiers Otic Drugs for External and Middle Ear Disorders Copyright © 2014 by Mosby, an imprint of Elsevier Inc.7

8.  Topical formulations applied to the external ear  Often combined with steroids for antiinflammatory, antipruritic, and antiallergic drug effects  Middle ear infections generally require systemically administered antibiotics Antibacterial and Antifungal Otic Drugs Copyright © 2014 by Mosby, an imprint of Elsevier Inc.8

9.  Antibiotics  neomycin and polymyxin B plus hydrocortisone combination (Cortisporin Otic)  Others containing ciprofloxacin  ofloxacin  Antifungals  Cortic (combination of antifungal drugs and hydrocortisone) Antibacterial and Antifungal Otic Drugs (cont’d) Copyright © 2014 by Mosby, an imprint of Elsevier Inc.9

10.  carbamide peroxide (Debrox)  Combined with other drugs, such as glycerin, to loosen and help remove cerumen  Ear canal irrigation with water may be needed Earwax Emulsifiers Copyright © 2014 by Mosby, an imprint of Elsevier Inc.10

11. Classroom Response Question When teaching an adult patient about eardrops, which statement will the nurse include? A.“Hold your ear down and back to instill the drops.” B.“If you feel dizzy after instilling the ear drops, stand up and walk around the room.” C.“Warm the ear drops up for 30 seconds in the microwave before using them.” D.“Lie on the opposite side of that of your affected ear for about 5 minutes after instilling the drug.” Copyright © 2014 by Mosby, an imprint of Elsevier Inc.11

12.  Assess baseline hearing or auditory status  Evaluate patient’s symptoms  Assess drug and food allergies  Assess for contraindications  Keep in mind that perforated eardrum(s) may be a contraindication to these drugs  Ciprofloxacin and ofloxacin can be used with perforated eardrums. Nursing Implications Copyright © 2014 by Mosby, an imprint of Elsevier Inc.12

13.  If necessary or if ordered, remove cerumen by irrigation before instilling eardrops  Cleanse outer ear thoroughly Nursing Implications (cont’d) Copyright © 2014 by Mosby, an imprint of Elsevier Inc.13

14.  Warm eardrops to approximately body temperature before instillation  Allow refrigerated solutions to warm to room temperature  Keep in mind that cold eardrops may cause vomiting and dizziness Nursing Implications (cont’d) Copyright © 2014 by Mosby, an imprint of Elsevier Inc.14

15. Classroom Response Question While administering medications, the nurse finds a patient’s eardrops in the medication refrigerator. If the nurse gives the eardrops immediately, what response might the patient have? A.No unusual response B.Immediate relief of ear discomfort C.A vestibular-type reaction D.Increased ear pain Copyright © 2014 by Mosby, an imprint of Elsevier Inc.15

16.  When administering eardrops to adults  Hold the pinna up and back  When administering eardrops to children younger than 3 years  Hold the pinna down and back Nursing Implications (cont’d) Copyright © 2014 by Mosby, an imprint of Elsevier Inc.16

17.  Allow time for eardrops to flow down into the ear canal  Have patients lie on the side opposite to the side of the affected ear for about 5 minutes after instilling eardrops Nursing Implications (cont’d) Copyright © 2014 by Mosby, an imprint of Elsevier Inc.17

18.  A small cotton ball may be gently inserted into the ear canal to keep the drug in, but do not force the cotton into the ear canal  Gently massage the tragus of the ear to encourage flow of medication Nursing Implications (cont’d) Copyright © 2014 by Mosby, an imprint of Elsevier Inc.18

19. Classroom Response Question Gentle massage of the tragus area of the ear after administering eardrops results in A.decreased absorption of the medication. B.softening of the cerumen in the ear canal. C.increased coverage of the medication in the ear canal. D.reduced pain in the ear. Copyright © 2014 by Mosby, an imprint of Elsevier Inc.19